Wholistic orthopedics: Is this the right way to treat geriatric orthopedic patients?

Geriatric orthopedic problems poses different challenges in their management. Conventional treatment methods like drugs, physiotherapy and surgeries are inadequate. A Geriatric orthopedic patient suffers as a whole and not in isolation. This article highlights the importance of managing geriatric orthopedic patients as a whole and outlines the various steps of wholistic management.

Role of integrated approach of yoga therapy in a failed post-total knee replacement of bilateral knees.

OA Knee is the most common arthritis. Knee replacement Surgeries are being done increasingly in the present times. This has led to the violation of the standard indications and when knees are replaced ignoring other co - musculoskeletal conditions it results in the surgery failing early. This is about a patient who encountered a failed TKR due to improper selection as patient had bilateral OA Hip that was ignored in the initial stages. To overcome the problem she was advised bilateral hip replacement which would leave her with four replacements in the lower limb. She refused surgery and was told there are no alternative treatment options. This patient underwent a 3 week integrated course of IAYT at our center and she made a remarkable recovery. IAYT is a good non-surgical treatment that can be affective both before and after knee replacement and it should be considered as the first choice of treatment before surgery.

Effects of an integrated approach of hatha yoga therapy on functional disability, pain, and flexibility in osteoarthritis of the knee joint: a randomized controlled study.

OBJECTIVES: The study objectives were to evaluate the efficacy of integrating hatha yoga therapy with therapeutic exercises for osteoarthritis (OA) of the knee joints. DESIGN: This was a prospective, randomized, active controlled trial. Two hundred and fifty (250) participants who had OA knees and who were between 35 and 80 years (yoga 59.56±9.54) and (control 59.42±10.66) from the outpatient department of Ebnezar Orthopedic Center, Bengaluru, were randomly assigned to receive hatha yoga therapy or therapeutic exercises after transcutaneous electrical stimulation and ultrasound treatment (20 minutes per day). Both of the groups practiced supervised interventions (40 minutes per day) for 3 months. One hundred and eighteen (118) (yoga) and 117 (control) subjects were available for the final analysis. RESULTS: There were significant differences within (Wilcoxon's, p<0.001) and between the groups (Mann-Whitney U, p<0.001) on all the variables, with better improvements in the yoga than the control groups. Walking pain in the yoga (37.3%, 64.9%) and control (24.9%, 42%), knee disability in the yoga (59.7%, 83%) and control (32.7%, 53.6%), range of knee flexion in yoga (12.7%, 26.5% right, 13.5%, 28% left) and control (6.9%, 13.3% right, 5.6%, 11.5% left), joint tenderness in yoga (52.3%, 86.1%) and control (28%, 57.1%), swelling in yoga (55.4%, 85.9%) and control (32.1%, 60%), crepitus in yoga (44.0%, 79.9%) and control (27.0%, 47.8%) and walking time in yoga (26.6%, 52.8%) and control (9.3%, 21.6%), all improved more in the yoga than the control groups on the 15th and 90th day, respectively. CONCLUSIONS: An integrated approach of hatha yoga therapy is better than therapeutic exercises as an adjunct to transcutaneous electrical stimulation and ultrasound treatment in improving walking pain, range of knee flexion, walking time, tenderness, swelling, crepitus, and knee disability in patients with OA knees.

Effect of integrated yoga therapy on pain, morning stiffness and anxiety in osteoarthritis of the knee joint: A randomized control study.

AIM: To study the effect of integrated yoga on pain, morning stiffness and anxiety in osteoarthritis of knees. MATERIALS AND METHODS: Two hundred and fifty participants with OA knees (35-80 years) were randomly assigned to yoga or control group. Both groups had transcutaneous electrical stimulation and ultrasound treatment followed by intervention (40 min) for two weeks with follow up for three months. The integrated yoga consisted of yogic loosening and strengthening practices, asanas, relaxation, pranayama and meditation. The control group had physiotherapy exercises. Assessments were done on 15(th) (post 1) and 90(th) day (post 2). RESULTS: Resting pain (numerical rating scale) reduced better (P<0.001, Mann-Whitney U test) in yoga group (post 1=33.6% and post 2=71.8%) than control group (post 1=13.4% and post 2=37.5%). Morning stiffness decreased more (P<0.001) in yoga (post 1=68.6% and post 2=98.1%) than control group (post 1=38.6% and post 2=71.6%). State anxiety (STAI-1) reduced (P<0.001) by 35.5% (post 1) and 58.4% (post 2) in the yoga group and 15.6% (post 1) and 38.8% (post 2) in the control group; trait anxiety (STAI 2) reduced (P<0.001) better (post 1=34.6% and post 2=57.10%) in yoga than control group (post 1=14.12% and post 2=34.73%). Systolic blood pressure reduced (P<0.001) better in yoga group (post 1=-7.93% and post 2=-15.7%) than the control group (post 1=-1.8% and post 2=-3.8%). Diastolic blood pressure reduced (P<0.001) better in yoga group (post 1=-7.6% and post 2=-16.4%) than the control group (post 1=-2.1% and post 2=-5.0%). Pulse rate reduced (P<0.001) better in yoga group (post 1=-8.41% and post 2=-12.4%) than the control group (post 1=-5.1% and post 2=-7.1%). CONCLUSION: Integrated approach of yoga therapy is better than physiotherapy exercises as an adjunct to transcutaneous electrical stimulation and ultrasound treatment in reducing pain, morning stiffness, state and trait anxiety, blood pressure and pulse rate in patients with OA knees.

Effect of an integrated approach of yoga therapy on quality of life in osteoarthritis of the knee joint: A randomized control study.

AIM: This study was designed to evaluate the efficacy of addition of integrated yoga therapy to therapeutic exercises in osteoarthritis (OA) of knee joints. MATERIALS AND METHODS: This was a prospective randomized active control trial. A total of t participants with OA of knee joints between 35 and 80 years (yoga, 59.56 ± 9.54 and control, 59.42 ± 10.66) from the outpatient department of Dr. John's Orthopedic Center, Bengaluru, were randomly assigned to receive yoga or physiotherapy exercises after transcutaneous electrical stimulation and ultrasound treatment of the affected knee joints. Both groups practiced supervised intervention (40 min per day) for 2 weeks (6 days per week) with followup for 3 months. The module of integrated yoga consisted of shithilikaranavyayama (loosening and strengthening), asanas, relaxation techniques, pranayama, meditation and didactic lectures on yama, niyama, jnana yoga, bhakti yoga, and karma yoga for a healthy lifestyle change. The control group also had supervised physiotherapy exercises. A total of 118 (yoga) and 117 (control) were available for final analysis. RESULTS: Significant differences were observed within (P < 0.001, Wilcoxon's) and between groups (P < 0.001, Mann-Whitney U-test) on all domains of the Short Form-36 (P < 0.004), with better results in the yoga group than in the control group, both at 15(th) day and 90(th) day. CONCLUSION: An integrated approach of yoga therapy is better than therapeutic exercises as an adjunct to transcutaneous electrical stimulation and ultrasound treatment in improving knee disability and quality of life in patients with OA knees.

The effect of add-on yogic prana energization technique (YPET) on healing of fresh fractures: a randomized control study.

OBJECTIVES: The objective was to study the effect of the add-on yogic prana energization technique (YPET) on healing of fresh fractures. MATERIALS AND METHODS: Thirty (30) patients (22 men and 8 women) between 18 and 55 years with simple extra-articular fractures of long and short bones were selected from the outpatient department of Ebnezar Orthopaedic Centre and Parimala Speciality Hospital, Bengaluru. They were randomized into yoga (n = 15) and control (n = 15) groups. Compound, complicated, pathologic fractures, old fractures, and those associated with dislocations were excluded. Both groups received the conventional plaster of paris immobilization of the fracture site as the primary treatment. The yoga group, in addition, practiced YPET twice a day (30 minutes/session) for 2 weeks using taped audio instructions after learning under supervision for 1 week. YPET is an advanced yoga relaxation practice that involves breath regulation, chanting, and visualization, which according to yogic science revitalizes the tissues by activating the subtle energies (prana) within the body. Both the groups were assessed on the 1st and 21st day by the Numerical Pain Rating Scale for pain (NRS), tenderness (0-4), swelling (0-4), fracture line density (1-4), and the bridging of cortices (1-4). RESULTS: Two (2) groups were matched on all variables. The Wilcoxon test showed significant improvement in both groups on all variables. Pain reduction (NRS) was better (p = 0.001 Mann-Whitney test) in the YPET group (94.5%) than in the control group (58.6%); Tenderness reduced (p = 0.001) better in the YPET group (94.4 %) than in the control group (69.12%); Swelling reduced by 93% in the YPET group and by 69.4% in controls (between-groups p = 0.093, i.e., nonsignificant); increase in fracture line density was better (p = 0.001) in the YPET group (48%) than in the control group (18.25%). The number of cortices united was significantly better (p = 0.001) in the YPET group (81.4%) than in controls (39.7 %). CONCLUSIONS: Add-on yoga-based YPET accelerates fracture healing.

Efficacy of Agnikarma over the padakanistakam (little toe) and Katibasti in Gridhrasi: A comparative study.

BACKGROUND AND OBJECTIVES: Gridhrasi (Sciatica) is one of the Vatavyadhi which is caused by aggravated Vata dosha. This disease is characterized by ruja (pain) in the waist, back, thigh, knee and calf regions along the course of sciatic nerve. In spite of the different types of treatment modalities mentioned in ancient and modern medical sciences, they have some or the other shortcomings and drawbacks. Considering all these, the present study was taken up with the objective of evaluating the efficacy of Agnikarma (treatment done with cauterization) over the padakanistakam (little toe) in the management of Gridhrasi. To consider the significance of the method of Agnikarma, the efficacy of Katibasti in the management of Gridhrasi which has been established in the previous work was also studied. MATERIALS AND METHODS: The study was performed after obtaining Ethics Committee approval and patients' written informed consent. Forty cases presenting with classical features of Gridhrasi (Sciatica) due to lumbar intervertebral disc prolapse were selected. The management of Gridhrasi by Agnikarma and Katibasti was conducted by including the patients in two groups, namely Group A (study group) and Group B (control group). The data were collected and the observations were made before the treatment, on 8(th) day, 15(th) day and on 22(nd) day of the treatment. The data obtained from the results were subjected for statistical analysis and conclusions were drawn. RESULTS: There was a significant reduction in the parameters, pain (P < 0.01) and straight-leg raising (SLR) test (P < 0.01), of the study group compared to the control group (P < 0.01). Pain was assessed through Numerical Pain Analogue Scale. After the treatment with Agnikarma, the pain was totally relieved in 80% of cases. It was reduced to moderate degree in 20% of cases and in 95% of cases, SLR test became negative. After the treatment with Katibasti, the pain was totally relieved in 50% of cases. It was reduced to moderate degree in 20% and to mild degree in 25% of cases. In 60% of cases, SLR test became negative. However, changes in the radiological findings were not found in both the methods of management. Analysis of overall effect of treatment in the present study reveals that Agnikarma was Both the procedures were conducted in to that of Katibasti. CONCLUSIONS: The management of Gridhrasi by Agnikarma was more efficacious as compared with Katibasti in reducing pain. However, there were no radiological changes produced by both the methods of treatment. Further studies may be conducted by future scholars by taking more samples with more number of sittings.